Trends in cardiovascular disease mortality among older adults with co-occuring lung cancer in the United States from 1999 to 2020

Lung cancer is a prevalent global malignancy and cardiovascular disease (CVD) is a leading cause of mortality in older adults. Their coexistence is common in the elderly, exacerbated by shared risk factors and treatment cardiotoxicity. Despite improved lung cancer survival, the CVD mortality burden among patients with concurrent lung cancer remains under-investigated, particularly regarding long-term trends and demographic disparities. This study aimed to investigate CVD mortality trends from 1999 to 2020 among U.S. adults aged 65 + with lung cancer and explore disparities by sex, race, and geography. Data from the CDC WONDER database. Multiple-cause-of-death records (1999–2020) were analyzed to identify decedents with CVD as the underlying cause of death and lung cancer listed as a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by year, race and geographic region. Joinpoint regression analysis estimated annual percentage changes (APCs) and average annual percentage changes (AAPCs); pairwise comparisons were performed to assess significant differences in trends between subgroups. From 1999–2020, a total of 69,435 CVD-related deaths were identified among old adults with co-occurring lung cancer. The overall AAMR declined significantly (AAPC: -3.19, 95% CI: -3.62 to -2.76). The AAMR was markedly higher in males (11.13 per 100,000) than females (5.14 per 100,000). Stratification by race revealed that Black or African American (7.82; 95% CI: 7.62–8.01) and White (7.74; 95% CI: 7.67–7.80) individuals had comparably elevated AAMRs, while Asian or Pacific Islander populations reported the lowest rates. Geographic analysis indicated higher AAMRs in rural than urban regions, with the Northeast reporting the highest rate. Substantial interstate disparities were evident; New York's AAMR was more than four times that of Utah. This declining trend was consistent with overall CVD mortality trends, though the reduction was more pronounced among males with both conditions. This study systematically characterizes long-term trends and demographic/geographic disparities in CVD mortality among the elderly U.S. population with concurrent lung cancer. Our findings underscore the profound influence of sex, race, and geographic factors on this mortality burden. These findings provide a robust evidence base for identifying high-risk populations, optimizing clinical management of these comorbidities, and guiding targeted public health interventions.